Investigation and treatment of Morton’s neuroma

The normal foot contains many nerves. The sole of the foot in particular is a very sensitive area due to its dense innervation. The medial and lateral plantar nerves (shown in the diagram below) supply these areas and protect our feet from painful trauma. A Morton’s neuroma occurs when one of the branches to the toes becomes painful and thickened.

Medial and lateral plantar nerves to the sole of the foot (shown in yellow). Morton’s neuroma most commonly affects the nerve supplying the 3rd / 4th toes.

The most common site for this problem is in the lateral branch of the medial plantar nerve that supplies the 3rd and 4th toes. The nerve becomes compressed in the space between the heads of the metatarsal bones and the soft tissue above / below.

Sketch showing thickened Morton’s neuroma between the heads of the metatarsal bones

Often the history (description) and examination will allow a foot and ankle specialist to make a diagnosis without the need for further imaging such as ultrasound or MRI scans. A weightbearing xray is essential however to exclude other causes of foot pain. If there is any doubt, then an ultrasound scan (or occasionally an MRI if appropriate) can be helpful. The title image shows an ultrasound picture of a typical neuroma.

There are many other reasons for forefoot pain that can form a differential diagnosis and must be excluded if a neuroma is to be confidently diagnosed. The differential diagnosis for Morton’s neuroma includes:

intermetarsal bursitis

plantar plate rupture​

metatarsophalangeal joint capsulitis

metatarsal stress fractures

metatarsalgia

lumbar radiculopathy

tarsal tunnel syndrome

Frieberg’s infraction

infection

tumors (such as synovial sarcoma)

painful callosities

rheumatoid nodule

peripheral neuropathy

Conservative treatment and the help of a good podiatrist can make a big difference to many people with a painful neuroma.

If this fails to settle the problem, then treatment with an injection can be very helpful. An injection is quick and simple to administer and can be done at the same time as an outpatient appointment.

We have found in Harrogate that about 60% of people who receive an injection in the outpatient clinic for a Morton’s neuroma do not need any additional treatment. We presented these results recently to the SICOT meeting in Rome. See the following links for more information.

Topics

Subscribe via Email

Enter your email address to subscribe to this blog and receive notifications of new posts by email.

Email Address

Testimonials

Total ankle replacement

Prior to a total ankle replacement in December 2014, arthritic ankle joints severely restricted my daily life and walking was extremely painful. My life is good again.
Mr Farndon listened to me, assessed my problems and discussed with clarity and charm the options available to me.
With the expertise, care and attention of Mr Farndon I am now able to enjoy life almost pain free and lead an active life again (gardening, pilates, circuit training).
With best wishes.

Gail Nicolaidis

Mark Farndon is an orthopaedic surgeon specialising in knee, foot and ankle surgery in Leeds and Harrogate, Yorkshire.